title: Subjective quality of life in war-affected populations.
abstract: BACKGROUND
  Exposure to traumatic war events may lead to a reduction in quality of life for many years. Research suggests that these impairments may be associated with posttraumatic stress symptoms; however, wars also have a profound impact on social conditions. Systematic studies utilising subjective quality of life (SQOL) measures are particularly rare and research in post-conflict settings is scarce. Whether social factors independently affect SQOL after war in addition to symptoms has not been explored in large scale studies.
  
  
  METHODS
  War-affected community samples were recruited through a random-walk technique in five Balkan countries and through registers and networking in three Western European countries. The interviews were carried out on average 8 years after the war in the Balkans. SQOL was assessed on Manchester Short Assessment of Quality of Life--MANSA. We explored the impact of war events, posttraumatic stress symptoms and post-war environment on SQOL.
  
  
  RESULTS
  We interviewed 3313 Balkan residents and 854 refugees in Western Europe. The MANSA mean score was 4.8 (SD = 0.9) for the Balkan sample and 4.7 (SD = 0.9) for refugees. In both samples participants were explicitly dissatisfied with their employment and financial situation. Posttraumatic stress symptoms had a strong negative impact on SQOL. Traumatic war events were directly linked with lower SQOL in Balkan residents. The post-war environment influenced SQOL in both groups: unemployment was associated with lower SQOL and recent contacts with friends with higher SQOL. Experiencing more migration-related stressors was linked to poorer SQOL in refugees.
  
  
  CONCLUSIONS
  Both posttraumatic stress symptoms and aspects of the post-war environment independently influence SQOL in war-affected populations. Aid programmes to improve wellbeing following the traumatic war events should include both treatment of posttraumatic symptoms and social interventions.
authors.affiliation: Unit for Social and Community Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Cherry Tree Way, London E13 8SP, United Kingdom. a.matanov@qmul.ac.uk.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Matanov
authors.forename: Domenico
authors.initials: D
authors.lastname: Giacco
authors.forename: Marija
authors.initials: M
authors.lastname: Bogic
authors.forename: Dean
authors.initials: D
authors.lastname: Ajdukovic
authors.forename: Tanja
authors.initials: T
authors.lastname: Franciskovic
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Galeazzi
authors.forename: Abdulah
authors.initials: A
authors.lastname: Kucukalic
authors.forename: Dusica
authors.initials: D
authors.lastname: Lecic-Tosevski
authors.forename: Nexhmedin
authors.initials: N
authors.lastname: Morina
authors.forename: Mihajlo
authors.initials: M
authors.lastname: Popovski
authors.forename: Matthias
authors.initials: M
authors.lastname: Schützwohl
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D063368:Balkan Peninsula; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012036:Refugees / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D011795:Surveys and Questionnaires; D014857:Warfare